Examining the Link Between Substance Use and Domestic Violence

By Dr. Richard Juman 09/17/15

The Fix Q&A with award-winning researcher Dr. Kenneth Leonard.

Dr. Kenneth Leonard
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Dr. Kenneth Leonard, director of the prestigious Research Institute on Addictions at the University of Buffalo, recently received the Distinguished Scientific Contributions Award from the American Psychological Association’s Society of Addiction Psychology. Dr. Leonard’s research has primarily focused on the impact of alcohol and/or substance misuse on family relatedness, especially in connection to intimate partner violence. His innovative research has helped a generation of clinicians attain an improved understanding of the connection between substance misuse and partner violence. Here, he summarizes his contributions to the field of addiction medicine…Dr. Richard Juman

Looking back on your body of work to date, what aspects do you feel have had the most significant impact on the addiction field? 

Kenneth Leonard: There have been two aspects of our work that I think have had the greatest impact. The first of these has been our work on substance use and intimate partner violence. We began this work in the late 1980s, focusing primarily on alcohol use. At that time, there were consistent findings from college students in laboratory studies that acute alcohol consumption resulted in increased aggression, and although based largely on one study and cross-cultural observations, there was a growing sense that intoxication was used as an excuse for aggression, but did not have any causal impact. There was also some cross-sectional research that found that heavy drinking patterns were associated with the occurrence and frequency of partner violence. Over the years, we expanded the methods that were used to examine this issue, conducting longitudinal, event-based, and experimental studies with newlyweds. While there is still some controversy, I think that our work, supported by the work of other colleagues, has demonstrated that alcohol contributes in a causal way to the occurrence or severity of intimate partner violence, though it is by no means the only factor. I think that our work has also helped to shape our understanding that alcohol contributes to partner violence among individuals and couples with specific characteristics, hopefully opening the door to possible interventions. 

The second aspect of our work that has had an impact is the research focused on how couples and their social environment influence, and are influenced, by excessive drinking, beyond the effects on violence. This work has shown that marriage has an impact on drinking and that married individuals change their drinking behavior in response to each other's drinking and their peers' drinking. We have also shown that couples with similar heavy drinking patterns have relatively high marital satisfaction and low separation and divorce rates, much like couples with similar light drinking or abstention patterns. Couples with very dissimilar patterns of heavy drinking, in contrast, have lower satisfaction and are more likely to separate and divorce.

Can you take us behind the scenes with respect to how one of your experimental studies with actual married couples was designed and how you got your data?

I was trained as a clinical psychologist by a social/personality psychologist, and did a post-doctoral fellowship in epidemiology; I have always tried to combine key aspects of each of these areas in my research. So, in my initial research, I developed an epidemiological study to address some aspects of the alcohol/violence relationship and then drew eligible couples from the epidemiological study for the experimental study. When I started looking at alcohol and marital violence, it was clear to me that this relationship might be very different for couples who had been married for a long time in contrast to newly married couples. In addition, studies of couples that had been married for some time represented "survivors," and heavy drinking and violent couples would be less likely to last. That meant that a study that used a broad section of married couples would be mixing very different types of couples together.   

My initial thought and plan was to use marriage license records to identify couples at the beginning of their marriage. While marriage licenses are "public records," in some states they are more public than in others, and New York was one of the less public states. As a result, we turned to directly interviewing couples as they waited to apply for their marriage license. This turned out to be very fortuitous, as couples were more than happy to do a brief screening and to listen to our explanation of the study. As a result, we were able to recruit a much higher percentage of newlyweds than other studies that called or mailed newlyweds.  

I would imagine that couples in which problem drinking emerged would be difficult to keep engaged in the research? 

There were challenges to keeping couples engaged in the research, but surprisingly, heavy drinking was not related to whether the couples stayed in the studies or not. For the most part, the data collection involved interviews and questionnaires, and they were adequately compensated for their time (usually 1-2 hours). Couples who were older, European-American ethnicity, or more highly educated were most likely to stay in the study.  Couples in which the wife was unhappy in the marriage were more likely to drop out. 

In general, we have been successful in keeping many couples (and families) in the research when they commit to a certain timeframe. So, when we tell them that the study will consist of three assessments over a two-year period, we have very low attrition for those assessments. When we've then received funding to continue the assessments, we often experience an increase in attrition. 

Have you been able to identify any mitigating factors that are characteristic of couples where there might be heavy drinking but without any associated partner violence?

In our research, many of our findings suggest that heavy drinking is most strongly related to violence among individuals with high levels of hostility, as reflected in aversive verbal interactions or measures of trait anger. We have reported such findings in both cross-sectional and longitudinal studies. This fits with the Alcohol Myopia model of the effects of intoxication. In one longitudinal study, we found that anger and avoidance coping together predicted a stronger alcohol-violence relationship. This suggests that alcohol has its strongest effect among individuals who are easily angered and less able to cope effectively. We have continued to explore this issue and hope to have a couple of papers in the next year addressing this. 

Have you been able to identify the interventions that are most effective with couples that are struggling with problem drinking?  

Our research has not really focused on interventions. However, research by Tim O'Farrell his and colleagues, and Barbara McCrady and her colleagues, has shown that incorporating marital treatment into cognitive-behavioral interventions is more effective than the cognitive-behavioral interventions alone. Tim's research has also shown that partner violence decreases with successfully treated alcoholism, whether the treatment is individual or couple focused. But there are certain violent alcoholics that should not be treated in a couples context. The issue of couples treatment for alcoholics and substance abusers is very important, and Dr. O'Farrell and Dr. McCrady have made important contributions, and so has Dr. Greg Stuart. Those interested in these clinical issues should look at their work.   

Where do you see things moving in the field around the issues that you have focused on? 

I think that I'd just like to say that as more and more research breakthroughs occur in neuroscience and genetics, it is key to remember that the fundamental human context is critical and that context is all about relationships, whether that be parent-child, intimate partners, or peers. It is these relationships that provide meaning to our existence, and addiction has a deep impact on and is deeply impacted by these relationships. As we think about effectively addressing addictive behavior, we must always seriously consider this central role of relationships. 

Kenneth Leonard, PhD, is the director of the Research Institute on Addictions at the University of Buffalo. His research has been widely published, appearing in Addiction, the Journal of Clinical Child and Adolescent Psychology, the Journal of Substance Abuse Treatment and many others. 

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Dr. Richard Juman is a licensed clinical psychologist who has worked in the field of addiction for over 25 years. He has treated hundreds of patients as a clinician and also provided supervision, program development and administration in a variety of settings including acute care hospitals, long term care facilities and outpatient chemical dependency centers. Find him on LinkedIn and Twitter.